Awareness and Attitude of Emergency Medical Care of Flight Cabin

Transcription

1 Awareness and Attitude of Emergen Medical Care of Flight Cabin Crew in Korea 1 Roh Sang-Gyun, 2 Kim Jee-Hee, 3 Lee Jae-Gook 1, Department of Emergen Medical Services, Sunmoon University, emtno@hanmail.net *2, (Corresponding author) Department of Emergen Medical Technology, Kangwon National University, kjh1962@hanmail.net 3, Department of Emergen Medical Services, Sunmoon University, jklee1229@hanmail.net Abstract The aim of the study is to investigate the awareness and attitude of emergen care of flight cabin crew. In the event of emergen patient care, cabin crew must take charge as the first responder quickly. The basic emergen treatment knowledge of the cabin crew consisted of 80.5%~97.8% when the emergen scene happened in passenger, and the types of emergen cares that the cabin crew could take were bleeding control, fever, seizures, myocardial infarction, airway management, and partial airway obstruction management. The inappropriate emergen cares comprised 3.2%~20.0%. Airway obstruction may cause loss of consciousness and cardiac arrest. In the case of cardiac arrest, the cabin crew must know how to check breathing and use the automated external defibrillator (AED). Life-threatening cardiac arrest can happen to any passenger at any time, so the cabin crew should have the ability to cope with such emergen accidents and know how to apply the AED to cardiac arrest victims. 1. Introduction Keywords: Cabin crew, Cardiac Arrest, Emergen Care High quality of life makes overseas trips more popular and increases the need for better inflight services in Korea. Passengers want to receive the best and the most comfortable in-flight services. As the number of airplane passengers increases, the impact of in-flight services and accidents may have also risen. Flight attendants must be prepared for unexpected in-flight accidents which may happen in emergen situations. In order to provide the best services and travel safety information, flight attendants must be experts until the arrival of the destination. Civil aeronautics law defines that cabin crew is responsible for carrying out safety services for passengers in cases of emergen evacuations [1]. The role of flight attendants includes not only in-flight services but also safety care. Flight attendants must take charge of passenger safety and provide emergen care to injured passengers in cases of bad weather conditions, aircraft damage, and air turbulence. Flight attendants must receive medical emergen education because in-flight emergen needs rapid treatment and care. The aim of this study was to investigate the awareness of emergen care and in-flight accident prevention, and to provide emergen care. 2. Study methods The questionnaire consisted of 30 questions including 10 questions on internal medicine emergen care, 10 questions on basic life support, and 10 questions on general characteristics. The questionnaire was modified in consideration of aircraft emergen medical supplies and equipment, and demographic characteristics of attendants. Study subjects were aircraft attendants in Korea. From May 1 to July 31 in 2012, 270 sheets were distributed by mail, and 144 sheets were analyzed by SPSS (version 15.0 of SPSS, Inc., Chicago, USA). Journal of Convergence Information Technology(JCIT) Volume8, Number14, September

2 3. Results The respondents were all female in their 20s (37.5%), 30s (54.9%), and 40s (7.6%). The respondents were all university or college graduates. In terms of flight experience, 4-6 years accounted for 32.6% and above 11 years accounted for 27.8%. Regarding the last education of basic life support (BLS), 54.2% received BLS within the last 6 months and 34.7% within the last 7-12 months (Table 1). Table 1. General characteristics of the cabin crew (n=144) Variables Gender female 144(100.0) Age 20s 30s 40s 54(37.5) 79(54.9) 11(7.6) Education Flight experience The last education of BLS college graduates university graduates above master degree 1-3 years 4-6 years 7-10 years above 11 years below 6 months 7 ~ 12 months 13 ~ 18 months 19 ~ 24 months above 24 months 12(8.3) 125(86.8) 7(4.9) 26(18.1) 47(32.6) 31(21.5) 40(27.8) 78(54.2) 50(34.7) 1(.7) 4(2.8) 11(7.6) The awareness of internal medicine emergen care was as follows. To the question, "When the patient body temperature is above 39.0, you will cover the patient with blank", 18.1% of the respondents replied "Yes". To the question, "When the body temperature is above 39.0, you will flush the patient with warm water", 72.9% replied yes. To the question about providing sugar to an unconscious hypoglycemic patient, 77.1% said yes. To the question about semi-fowler's position in a dyspnea patient, 59.7% said yes. In the question of convulsion care, 40.3% said yes to the answer of immobilization of the limbs and head turning. To the question "Nose bleeding patient should lower the nose and compress the wings of the nose", 66.0% said yes. To the question about giving water to a patient having abdominal pain, 47.9% said yes. To the question "squeezing chest pain means myocardial infarction", 79.9% said yes. To the question "Head tilt and chin lift are the best airway management strategies for an unconscious patient", 79.2% said yes (Table 2). Table 2. Awareness level of internal medicine diseases (n=144) Questions Yes No When the patient body temperature is above 39.0, you will cover the patient with blank. When the body temperature is above 39.0, you will flush the patient with warm water. 26(18.1) 118(81.9) 105(72.9) 39(27.1) Providing sugar to an unconscious hypoglycemic patient 111(77.1) 33(22.9) Semi-fowler's position in a dyspnea patient 86(59.7) 58(40.3) In convulsion care, immobilization of the limbs and head turning 58(40.3) 86(59.7) Nose bleeding patient should lower the nose and compress the wings of the nose 95(66.0) 49(34.0) 383

3 Giving water to a patient having abdominal pain 69(47.9) 75(52.1) Squeezing chest pain means myocardial infarction 115(79.9) 29(20.1) Head tilt and chin lift are the best airway management strategies for an unconscious patient 114(79.2) 30(20.8) The awareness of cardiopulmonary resuscitation was as follows. To the question "Do you know head tilt and chin lift?", 98.6% of the respondents said yes. To the question, Do you know the Heimlich maneuver?, 84.7% said yes. In the case of anosis due to choking, 90.3% chose to perform the Heimlich maneuver. In the case of unconsciousness due to choking, 20.1% said they would perform chest compressions. In the case of a choking patient who can still speak, 81.3% of the respondents said that they would thrust the patient s abdomen to cough strongly. To the question "Have you received the cardiopulmonary resuscitation (CPR) education?", 99.3% said yes, and 24.3% of the respondents answered that adult CPR is 30:2 of chest compressions and breathing. To the question "Chest compression rate is per minute", 70.8% said yes. To the question "Automated external defibrillator (AED) can be used to infants", 4.2% of the respondents said yes (Table 3). Table 3. Awareness of cardiopulmonary resuscitation (n=144) Questions Yes No Do you know head tilt and chin lift? 142(98.6) 2(1.4) Do you know the Heimlich maneuver? 122(84.7) 22(15.3) In case of anosis due to choking, perform the Heimlich maneuver. 130(90.3) 14(9.7) In case of unconsciousness due to choking, perform chest compression. 29(20.1) 115(79.9) In case of a choking patient who can still speak, make the patient cough strongly. 117(81.3) 27(18.8) Have you received the CPR education? 143(99.3) 1(0.7) One rescue breathing for one second. 35(24.3) 109(75.7) Adult CPR is 30:2 of chest compressions and breathing. 121(84.0) 23(16.0) Chest compression rate is per minute. 102(70.8) 42(29.2) AED can be used to infants. 6(4.2) 138(95.8) In-flight patient diseases experienced by flight attendants were nose bleeding (75.0%), headache (66.7%), abdominal pain (63.2%), otalgia (45.8%), and dyspnea (45.1%). The most difficult types of patients were those with dyspnea (31.3%), abdominal pain (14.6%), and panic disorder (8.7%) (Table 4). Nose bleeding 108(75.0) Diabetes mellitus Table 4. of patients (n=144) 54(37.5) Headache 96(66.7) High fever 43(29.0) Abdominal pain 91(63.2) Otalgia 66(45.8) Panic disorder Hypervent ilation 39(27.1) Economy class syndrome External bleeding Convulsio n 29(20.1) Myocardial infarction 7(4.9) 20(13.9) Delivery 4(2.8) 20(13.9) 29(20.1) Asthma 9(6.3) Dyspnea 65(45.1) Abrasion 26(18.1) Angina 7(4.9) Cerebrovasc ular accident Cardiac arrest 4(2.8) 3(2.1) 384

4 Who is the most difficult patient? 4. Discussion and Conclusion pectoris Dyspnea, 45(31.3) Abdominal pain, 21(14.6) Panic disorder, 12(8.7) Nose bleeding, 14(7.6) Economy class syndrome 8(5.6) According to the Appendix of International Civil Aviation Treaty, flight attendants must receive and manipulate the skill training of oxygen supply, emergen medication, infection control equipment, and AED [2]. Domestic civil aeronautics law enforcement regulations article 218 defines that rescue equipment, oxygen supply, and automated external defibrillator must be educated within 12 months. Law on Emergen medicine article 14 defines that flight workers must receive emergen care education [3]. Australian Qantas Airline first introduced the AED in Boeing 747 and Boeing 767. Virgin Atlantic, Air Zimbabwe, Cathay Pacific Airlines introduced the AED [4][5]. Page et al. analyzed 200 cardiac arrest victims who received AED treatment during the period between1997 and 1999 in US Airlines [6]. The most common causes of the cardiac arrest were ventricular fibrillation, asystole, and pulseless idioventricular rhythm [4][5]. In 1992, Qantas Airline carried out CPR education to 4,000 flight attendants and prepared epinephrine, bicarbonate, and lidocaine in all aircrafts [5]. The most common patient type was nose bleeding (75.0%), and this was lower than that in kindergarten children (96.6%) [7]. This difference rate between the two groups was due to various majors of flight attendants. In contrast, kindergarten teachers learn about emergen care which is part of their curriculum. The experience rate of in-flight cardiac arrest was 13.8%. The rate of flight attendants receiving CPR education comprised 99.3%. The success rate of emergen care was 84.0% to 98.6% such as partial airway obstruction management, chest compression, and rescue breathing. On the other hand, 60.0% of the kindergarten teachers knew how to manage the emergen patients. Mahony et al. reported that CPR knowledge accounted for 88.0% [8]. The knowledge about the unconscious airway obstruction management accounted for 20.1%, and AED use on infant was 4.2%. Therefore, it is necessary to educate the flight attendants based on the new 2010 CPR guideline. The most difficult patients in the aircraft were those with dyspnea, abdominal pain and panic disorder. In order to provide effective patient care, pulse oximetry was chosen. Pulse oximetry is easy to use and is an applicable respiration measure [8]. Downdall reported that the most common symptoms were chest pain due to angina pectoris, collapse, head injury by luggage fall, anxiety and panic disorder, diarrhea, vomiting, hypoglycemia, and vaginal bleeding due to abortion [9]. The effect of education gradually diminishes if is it not applied. Safar et al. revealed that the effect of CPR effect did not last after 6 months from the date of education [10]. Berden et al. suggested that it was not appropriate to educate only once a year, and Choi et al. reported that it is necessary to educate 4 times a year [11][12]. Although the prevalence rate of in-flight emergen is low, it is important to educate flight attendants regarding emergen care and rescue equipment management and manual. Although the prevalence rate of in-flight emergen patient is low, it is very important to prepare the manual of emergen care and rescue equipment. 5. References [1] Retrieved June 3, 2013, from [2] ICAO Annex 6. Commercial Aircraft Operation Part 1 'International Commercial Air Transport Aeroplanes (Eighth Edition July 2001). [3] O'Rourke RA, "Saving lives in the sky", Circulation, 96, pp , [4] O'Rourke MF, Donaldson E, Feddes, "An airline cardiac arrest program", Circulation, vol. 96, no. 9, pp ,

5 [5] Page RL, Joglar JA, Kowa RC, Zagrodzky JD, Nelson LL, Ramaswamy K, Barrera SJ, Hamdan MH, McKena D, "Use of automated external defibrillators by U.S. Airline", The New England Journal of Medicine vol. 343, no 17, pp , October 26, /NEJM [6] Rho SG, A Study on the Basic Emergen Treatment Awareness Level of Kindergarten Teacher", J Korean Institute Fire Sci & Eng, vol. 21, no. 2, pp , [7] Mahony PH, Griffith RF, Larsen P, Powell D, Retention of knowledge and skills in first aid and resuscitation by airline cabin crew", Resuscitation, vol. 76, no. 3, pp , [8] 2010 Guidelines for CPR and ECC, AHA, [9] Downdall N, "Is there a doctor on the aircraft?" Top 10 in-flight medical emergencies, British Medical Journal(BMJ), vol. 321, no. 25, pp , November, [10] Safar P, Winchell SW, Teaching and testing lay and paramedical in cardiopulmonary resuscitation". Anesth Anag, vol. 45, pp , [11] Berden HJJM, Willems FF, Hendrick JMA, Pijls NH, Knape JTA, How frequen should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills?", BMJ, vol. 12; 306(6892), pp , [12] Choi YC, Lee CS, Wang SJ, Analysis of adult cardiopulmonary resuscitation skill performed by emergen medical technicians in fire department", J Korean Institute Fire Sci & Eng, vol. 18, no. 1, pp. 13-7,